Achieving target intraocular pressure based on initial baseline intraocular pressure 

Achieving target intraocular pressure based on initial baseline intraocular pressure 

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Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent...

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... In addition, glaucoma is the second leading cause of blindness, accounting for 14% of blindness causes [2]. Current scientific evidence indicates that lowering intraocular pressure (IOP) with medical, laser, and/or surgical treatment is effective in decreasing the risk of disease progression [3][4][5][6][7]. Nevertheless, several randomized clinical trials and clinical experience have shown that despite significant IOP lowering, some patients continue to show worsening optic nerve damage. ...
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The role of nutraceuticals in the treatment of glaucoma remains controversial. The aim of this study was to evaluate the effect of citicoline, vitamin C, and docosahexaenoic acid (DHA) in patients with glaucoma. Methods: This was a prospective, randomized study. Patients with glaucoma were randomized to one of four groups and treated for 3 months with vitamin C, DHA, citicoline, or a combination of DHA and citicoline. We conducted a complete ophthalmic examination and visual fields each month and calculated the slopes of field indices. Changes in visual field indices (VFIs) and their slopes were assessed in each group and compared. Results: Seventy-three persons were included in the study. Mean defect (MD) significantly improved (p = 0.001) from −9.52 ± 4.36 to −7.85 ± 4.36 dB during the study period in persons taking DHA + citicoline. Similarly, the mean VFI significantly improved (p = 0.001) in this group. The only treatment group showing a statistically significant improvement (p = 0.006) in the MD (from −0.1041 ± 0.2471 to 0.1383 ± 0.2544 dB/month) and VFI slope was the group treated with DHA+citicoline. Conclusions: The combination of oral treatment with DHA + citicoline significantly improved VF indices and their slopes in patients with glaucoma after 3 months of treatment.
... IOL has the advantages of simple operation, small incision, less tissue damage, rapid visual recovery, short operation time, and fewer complications compared to these other methods. Current findings indicate that IOL implantation can reduce intraocular pressure in patients with glaucoma [38]. This study's meta-analysis revealed that the intraocular pressure (IOP) of patients treated with intraocular lenses (IOLs) decreased significantly compared to that before treatment (MD = 8:64, 95% CI: 5.75-11.53; ...
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This study is aimed at investigating the efficacy of intraocular lens (IOL) implantation in patients suffering from glaucoma through meta-analysis of the previously published research. For this purpose, different literature databases were searched for identification of clinical studies published between January 2000 and January 2022 on evaluating IOL’s efficacy in treating glaucoma. RevMan 5.3 was used to conduct a meta-analysis of the pertinent data. The central anterior chamber depth (ACD), corneal endothelial cell counts, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anti-glaucoma medications (AGM), and axial length (AL) changes were compared, and the incidence of postoperative complications was thoroughly evaluated. The Cochran chi-square test was used to examine the heterogeneity of the evaluation results. According to the inclusion and exclusion criteria, 20 studies included 948 glaucomatous eyes. IOP was significantly lower than before treatment ( MD = 8.64 , 95 CI: 5.75-11.53; Z = 5.86 , P < 0.0001 ), while ACD increased significantly ( MD = − 1.38 , 95 percent CI: -1.74-1.02; Z = 7.49 , P < 0.0001 ). The corneal endothelial cell counts were homogeneous ( MD = 225.08 , 95% CI: -64.17 to -514.33; Z = 1.53 , P = 0.20 ). AGM utilisation decreased ( MD = 1.43 , 95% CI: 0.752.12, Z = 4.09 , P < 0.0001 ). AL decreased significantly ( MD = 0.31 ; 95% CI: 0.09-0.54; Z = 2.71 ; P = 0.007 ). The incidence of complications remained insignificant after IOL treatment ( OR = 1.05 , 95% CI: 0.42 to 2.60; Z = 0.10 , P = 0.92 ; P = 0.92 ). These findings indicate that IOL treatment can significantly reduce intraocular pressure, glaucoma drug use, and aqueous level (AL) in glaucoma patients while increasing the depth of the central anterior chamber. This study offers a theoretical foundation for selecting glaucoma treatment methods.
... Namely, all groups varied in their age, glaucoma stage, glaucoma type, lens status, prior laser history, prior surgical history, VA, IOP, and type of GDD implant. Previous studies have suggested that management of glaucoma in younger patients is typically more aggressive than in older eyes due to a larger cumulative impact of elevated IOP on the optic nerve [16,17]. It is therefore notable that medication burden was significantly lower in the pars plana group, given Journal of Ophthalmology that this cohort was relatively younger than the AC and sulcus cohorts and we expected medication burden to be higher based on age. ...
... It is therefore notable that medication burden was significantly lower in the pars plana group, given Journal of Ophthalmology that this cohort was relatively younger than the AC and sulcus cohorts and we expected medication burden to be higher based on age. With respect to glaucoma stage, the authors have recommended using a lower target IOP and therefore more aggressive medical/surgical management in eyes with more severe disease [17]. However, the target IOP concept is variably applied across providers and the rate at which glaucoma can progress at a given IOP level is unpredictable, thereby limiting reliance on this approach [18]. ...
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Purpose: To assess outcomes of anterior chamber (AC), sulcus, and pars plana (PP) glaucoma drainage device (GDD) placement in glaucoma patients. Patients and Methods. Retrospective evaluation of glaucoma patients who underwent GDD insertion in the AC, sulcus, or PP at Massachusetts Eye and Ear between November 2016 and May 2021. Patients who received AC, sulcus, and pars plana tubes were selected using simple random sampling, and the first 40 patients meeting inclusion criteria were analyzed. Main outcome measures were cumulative success probabilities from Kaplan-Meier (KM) analyses, intraocular pressure (IOP), medication burden, and complication rates. Results: The PP group had a larger proportion of Ahmed GDDs and was younger on average with less severe glaucoma compared to patients with AC or sulcus tubes. The PP group had a higher proportion of mixed-mechanism glaucoma and lower proportion of primary open-angle glaucoma. With success defined as IOP reduction ≥20% and 5 < IOP ≤ 21 mm Hg, the Kaplan-Meier cumulative success probabilities for all three GDD locations were not significantly different. No significant differences were found in complication rates between all groups after 3 months. Patients with PP GDD had significantly lower medication burden than those with AC or sulcus GDDs up to 1.5 years postoperatively (1.7 ± 1.1, 3.0 ± 1.4, and 2.8 ± 1.2 for PP, AC, and sulcus, respectively; P=0.017). Conclusion: PP GDDs may be more effective in lowering medication burden than AC or sulcus tubes without compromising long-term safety.
... Glaucoma, the commonest cause of irreversible blindness globally, is projected to increase by over 70% by the year 2040. 1 Not only does this blinding disease impact substantially on a patient's quality of life (QoL), 2 but treatment options to slow down disease progression, including long-term topical medication use and surgery, 3,4 can also place a high burden on patients in terms of costs and side effects. [5][6][7][8] With the transition to value-based care models, assessing the effectiveness of chronic disease interventions from the patient's perspective using patient-reported outcome measures (PROMs) is crucial 9 and is mandated by several regulatory agencies. ...
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Purpose: To evaluate the psychometric properties of glaucoma-specific quality of life (QoL) item banks (GlauCAT) and assess their performance using computerized adaptive testing (CAT) simulations. Methods: In this cross-sectional study, 293 participants with glaucoma (mean age ± SD, 70.7 ± 13.2 years; 45% female) answered 342 items in 12 QoL item banks (IBs): Activity Limitation (AL); Driving (DV); Convenience (CV); Economic (EC); Emotional (EM); General Symptoms (GS); Health Concerns (HC); Lighting (LT); Mobility (MB); Ocular Surface Symptoms (OS); Social (SC); and Visual Symptoms (VS). These IBs were assessed using Rasch analysis, and CAT simulations with 1000 simulated respondents were utilized to determine the average number of items to be administered to achieve moderate and high precision levels. Results: The AL, DV, EM, HC, LT, MB, EC, OS, SC, and VS IBs required relatively minor amendments to achieve satisfactory psychometric fit. To resolve multidimensionality, we split CV into Treatment Convenience (TCV) and General Convenience (GCV). Due to poor measurement precision, the GS IB was not pursued further. This resulted in 12 total IBs. In CAT simulations, an average of 3.7 and 7.3 items per IB were required to attain measurement at moderate and high precision, respectively. Conclusions: Following rigorous psychometric assessment, we developed 12 valid glaucoma-specific QoL domains that can obtain highly precise person measure estimates using a small number of items. Translational relevance: GlauCAT will enable researchers and clinicians to quickly and comprehensively assess the impact of glaucoma and its associated interventions across a range of QoL domains.
... e stage of glaucoma was significant risk factor of time to blindness of glaucoma patients. is conclusion was supported by a study conducted in the United Kingdom [31] and several scholars' research [29,32,33]. A patient with moderate, advanced, and absolute stage of glaucoma were at higher risk of blindness than that of the early stages glaucoma. ...
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Background: Glaucoma is one of the most frequent vision-threatening eye diseases. It is frequently associated with excessive intraocular pressure (IOP), which can cause vision loss and damaged optic nerves. The main objective of this study was to model time to blindness of glaucoma patients by using appropriate statistical models. Study Design. A Retrospective Community-Based Longitudinal Study design was applied. Materials and Procedures. The data were obtained from Ophthalmology Department of JUSH from the period of January 2016 to August 2020. The glaucoma patient's information was extracted from the patient card and 321 samples were included in the study. To discover the factors that affect time to blindness of glaucoma patients', researchers used the Accelerated Failure Time (AFT) model. Results: 81.3 percent of the 321 glaucoma patients were blind. Unilaterally and bilaterally blinded female and male glaucoma patients were 24.92 and 56.38%, respectively. After glaucoma disease was confirmed, the median time to the blindness of both eyes and one eye was 12 months. The multivariable log-logistic accelerated failure-time model fits the glaucoma patient's time to blind dataset well. The result showed that the chance of blindness of glaucoma patients who have absolute stage of glaucoma, medium duration of diagnosis, long duration of diagnosis, and IOP greater than 21 mmHg were high with parameters (ϕ = 2.425, p value = 0.049, 95% CI [2.249, 2.601]), (ϕ = 1.505, p value = 0.001, 95% CI [0.228, 0.589]), (ϕ = 3.037, p value = 0.001, 95% C.I [2.850, 3.22]) and (ϕ 0.851, p value = 0.034, 95% C.I [0.702, 0.999]), respectively. Conclusion: The multivariable log-logistic accelerated failure time model evaluates the prognostic factors of time to blindness of glaucoma patients. Under this finding, duration of diagnosis, IOP, and stage of glaucoma were a key determinant factors of time to blindness of glaucoma patients'. Finally, the log-logistic accelerated failure-time model was the best-fitted parametric model based on AIC and BIC values.
... Therefore, most of the uncomplicated glaucoma follow-up patients can be monitored using other methods [9]. In a regular followup visit, an in-person conversation and assessment of the patient by an ophthalmologist would be optimal; however, most patients do not require a change in treatment strategy [10] and could thus benefit from asynchronous teleophthalmology, which delivers the benefits of facilitated access to examinations, less waiting time, and regular follow-ups. In effect, specialized ophthalmologists could devote more time to urgent patients and handle remote areas. ...
Article
Background: Coronavirus disease 2019 (COVID-19) has created an escalating need for limiting in-person examination and potential viral exposure. Under these circumstances, teleophthalmology allows ophthalmologists to continue providing care to patients while ensuring their safety and that of the medical staff. Objective: The primary objective of this study was to assess patient satisfaction with an asynchronous teleconsultation for glaucoma patients in a rural German area. Secondary endpoints were patient adherence and the need to change the therapeutic regime. Methods: This retrospective, observational, and monocentric study included 50 patients diagnosed with primary open-angle glaucoma (n = 49) and ocular hypertension (n = 1) requiring medication to lower intraocular pressure (IOP). Only patients with well-controlled diseases were included, and a brief questionnaire was evaluated, which was completed one year after the baseline visit. Best-corrected visual acuity (BCVA), IOP measurements, visual fields, optical coherence tomography images of the optic nerve head, ultra-widefield photographs of the fundus, and photographs of the anterior segment of the eye were taken at each visit by an experienced optometrist. Results: Of the 50 patients included, the mean number of follow-up visits in this observation period was 4.4. No patient was lost to follow-up, and there were a total of nine missed follow-up visits (but not lost to follow-up). No patients required a change in their treatment regime during the observational period. Regarding patient-focused assessment, the majority of patients were satisfied or very satisfied with teleconsultation in general. Conclusion: Asynchronous teleophthalmology is a promising option and effective means to monitor glaucoma patients. The majority of teleophthalmology patients were satisfied with their teleconsultation and adhered to the follow-up schedule. However, prospective trials with a larger number of patients and a more focused examination on specific patient populations are required. Further trials should also focus on the aspect of cost-effectiveness.
... [33] Though the criterion for success of the procedure in our study was an IOP of <21 mm Hg, studies suggest a value of <17 mm Hg to be more appropriate. [34] This might have been a confounding factor. One eye in the MMC group developed hypotony in the first week with an IOP of 6 mm Hg. ...
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Purpose: To comparatively evaluate in Indian eyes with coexisting cataract and primary open-angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy. Methods: Eyes with primary open-angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty-four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology. Results: In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 ± 2.89 mm Hg with MMC and 14.56 ± 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed. Conclusion: MMC and Ologen are both effective adjunctives in combined phaco-trabeculectomy. However, the Ologen implant provides better bleb health and safety.
... Glaucoma is a common eye disease caused by optic nerve atrophy and visual field defect (1). Primary glaucoma comprises angle-closure glaucoma and open-angle glaucoma (2); the most common type of glaucoma is primary open-angle glaucoma (POAG) (3). Glaucoma is the leading cause of irreversible vision loss and blindness (2). ...
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Glaucoma is an irreversible disease that causes blindness. Formation of a hypertrophic scar (HS) is the main cause of failure of glaucoma surgery. The long non-coding RNA LINC01605 is closely associated with the formation of HS; however, the function of LINC01605 in the formation and development of HS remains unclear. For this study, firstly, human Tenon's capsule fibroblasts (HTFs) and corneal epithelial cells (control cells) were collected from patients (n=5) with POAG who underwent glaucoma filtration surgery at Fuyang People's Hospital. Immunofluorescence analysis was performed to detect the expression levels of vimentin (one of the main components of medium fiber and plays an important role in the cytoskeleton and motility), keratin (the main component of cytoskeletal proteins) and LC3 (an autophagy marker). In addition, reverse transcription-quantitative PCR analysis was performed to detect LINC01605 expression. Besides, the Cell Counting Kit-8 assay was performed to assess the viability of human Tenon's capsule fibroblasts (HTFs). Next, flow cytometry was performed to detect HTF apoptosis. Furthermore, western blot analysis was performed for Bax, Bcl-2, Pro-caspase-3, cleaved caspase-3, phosphorylated (p-)Smad2, Smad2, α-SMA, MMP9, ATG7, p62, beclin 1, p-AMPK and AMPK in HTFs to determine the mechanism by which LINC01605 regulates the formation and development of HS. Moreover, a Transwell assay was performed to detect the migratory ability of HTFs. The results demonstrated that LINC01605 was significantly upregulated in HS tissues compared with that in normal (control/healthy) tissues. In addition, vimentin was highly expressed in HTFs, whereas keratin was expressed at a low level. Also, in HTFs, LINC01605 knockdown inhibited cell viability by inducing apoptosis, decreasing Smad2 activation and inhibiting autophagy. Furthermore, LINC01605 knockdown significantly inhibited the migratory ability of HTFs. Transfection with LINC01605 small interference RNAs significantly downregulated the expression levels of p-Smad2, α-SMA and MMP9 in HTFs. Furthermore, LINC01605 knockdown notably inhibited the viability and migration, and induced the apoptosis of HTFs, the effects of which were reversed following treatment with TGF-β. Taken together, the results of the present study suggested that LINC01605 knockdown may inhibit the viability of HTFs by inducing the apoptotic pathway. These findings may provide novel directions for the treatment of HS.
... The results of several randomised controlled clinical trials have consistently attributed a 10% higher risk for both the development and the progression of the disease to each higher single mmHg [29] (Miglior 2013). Many long-term, randomized trials have shown the efficacy of lowering IOP, either by a percentage of the baseline, or to a specified level [30]. Diniz-Filho et al. [31] studied the association between IOP and the rates of retinal nerve fiber layer loss in patients with glaucoma using spectral-domain optical coherence tomography, and they observed that a 1 mmHg increase in the average IOP at the follow-up was associated with an additional average loss of 0.20 µm/year in progressing eyes. ...
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The purpose of this study was to examine the relationship between glaucoma and cardiac abnormalities. We evaluated 581 patients with open-angle glaucoma (285 men and 296 women) and 595 individuals without glaucoma (273 men and 322 women). All of the participants underwent visual field testing using a Humphrey Visual Field Analyzer (30-2 program), an electrocardiogram (ECG), and blood pressure measurement. We examined the ECG abnormalities and other factors (age, intraocular pressure (IOP) and systemic hypertension) involved in the development and severity of glaucoma. Logistic regression analyses revealed significant correlations of glaucoma with IOP (OR = 1.43; 95% CI: 1.36–1.51; p < 0.00001), atrial fibrillation (OR = 2.02; 95% CI: 1.01–4.04; p = 0.04), left ventricular hypertrophy (LVH) (OR = 2.21; 95% CI: 1.15–4.25; p = 0.02), and bradycardia (OR = 2.19; 95% CI: 1.25–4.70; p = 0.02). Regression analyses revealed significant correlations of the mean deviation of the visual field with age (t = –6.22; 95% CI: −0.15, −0.08; p < 0.00001), IOP (t = −6.47; 95% CI: −0.42, −0.23; p < 0.00001), and LVH (t = −2.15; 95% CI: −3.36, −0.29; p = 0.02). Atrial fibrillation, LVH and bradycardia may decrease the cerebral blood flow, and may also affect the ocular blood flow. Cardiac abnormalities may be associated with the development and severity of glaucoma.
... Although other risk factors, including vascular dysfunction/ dysregulation, age, and genetic factors, have also been implicated in the pathophysiology, rise in intraocular pressure (IOP) is a crucial risk factor in the pathogenesis of the disease (2,3). Therefore, lowering of IOP is the main focus during treatment for glaucoma (4). However, ...
Article
Background: Glaucoma is the second leading cause of blindness in the world and is characterized by optic neuropathy and degeneration of retinal ganglion cells (RGCs). Our preliminary research found that acteoside can inhibit autophagy-induced apoptosis of RGCs via the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. However, it is unclear how acteoside activates the PI3K/AKT signaling pathway to prevents RGCs autophagic apoptosis. Methods: Animal and cell models were used in this study. Hematoxylin-eosin staining revealed pathological histology of retinas. The number of RGCs in retinas was counted using immunofluorescence. Malondialdehyde and superoxide dismutase were determined using enzyme-linked immunosorbent assay kits. Flow cytometry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining were used to detect cell apoptosis. The reactive oxygen species was determined by the Flow cytometry. The proteins were determined by Western blot. Results: The results showed that acteoside treatment significantly reduced RGC loss, oxidative stress, and autophagy, thereby preventing glaucoma exacerbation. Acteoside reversed caveolin 1 (Cav1) expression and PI3K/AKT signaling activation, according to Western blot results. Cav1 knockdown also reversed acteoside's effects on RGC loss, PI3K/AKT signaling pathway activation, autophagy and oxidative stress. Notably, 3-methyladenine, a PI3K inhibitor, reversed the effects of acteoside and Cav1 overexpression on RGC loss, oxidative stress, and autophagy. Conclusions: These finding imply that acteoside alleviates RGC loss and oxidative stress by activating of the PI3K/AKT signaling pathway by upregulating Cav1.